Abstract
Objective: To describe the clinical presentation, surgical management, and early outcomes of advanced scalp squamous cell carcinoma (cSCC) in Sudan.
Methodology: This retrospective, single-center study included all patients who presented with advanced scalp cSCC between January 2017 and December 2023.
Results: Eleven patients were identified (mean age 70 years; 81.8% male), most of whom reported chronic occupational exposure to ultraviolet radiation. Most presented with chronic non-healing ulcerated bleeding scalp wounds. The median tumor diameter was 5 cm. Ten patients underwent surgical excision with reconstruction using a local scalp flap in six patients and a split-thickness skin graft in four patients. One patient, who presented with skull destruction and exposure to intracranial contents, was referred to a specialized center. The immediate outcomes were favorable: 90% of participants experienced no complications, while 10% developed partial graft necrosis.
Conclusion: Advanced scalp cSCC in this cohort was characterized by delayed presentation and extensive local disease. In a limited-resource setting, surgical excision with an appropriate reconstructive method remains a feasible and effective primary treatment strategy.

Key words: Advanced scalp cSCC, Sudan, surgical reconstruction, resource-limited setting.